Program Performance Measurement

Choosing Wisely or Vicely

The press gave the Choosing Wisely initiative, unveiled several weeks ago, a great deal of attention.  Briefly, the ABIM foundation collaborated with Consumer Reports to produce Top 5 lists from nine specialty societies to identify "five tests or procedures commonly used in their field, whose necessity should be questioned and discussed."  It is a first step to engage patients and physicians in the shapeless "national conversation" on (sensibly) rationing that everyone speaks of, but never hears.  I write about it now, not just because this process is inevitable—which it is, but because the Society of Hospital Medicine is amongst the next group of eight to offer up recommendations. (more…)

The Same Readmissions Tune Keeps Playing. Not A Pleasant Melody.

Of note, a very nice commentary in today's NEJM regarding our inability to control 30-day readmissions, and the justifications (or lack thereof) for its continued use as a metric in judging inpatient quality.  I suggest everyone who works on the front lines read it: [...]Although a focus on readmissions may have good face validity, we believe that policymakers' emphasis on 30-day readmissions is misguided, for three reasons. First, the metric itself is problematic: only a small proportion of readmissions at 30 days after initial discharge are probably preventable, and much of what drives hospital readmission rates are patient- and community-level factors that are well outside the hospital's control. Furthermore, it is unclear whether readmissions always reflect poor quality: high readmission rates can be the result of low mortality rates or good access to hospital care. Second, although improving discharge planning and care coordination is a laudable goal, there are better, more…

The Patient Will Rate You Now

These days, I’d never consider trying a new restaurant or hotel without reading the on-line ratings on TripAdvisor or Yelp. I seldom even bother with professional restaurant or travel critics. Until recently, there was little patient-generated information about doctors, practices or hospitals to help inform patient decisions. But that is rapidly changing, and the results may be every bit as transformative as they have been in traditionally consumer-centric industries like hospitality. Medicine has never thought much of the wisdom of crowds, but the times, as the song goes, they are a-changin’. Even if one embraces the value of listening to the patient, several questions arise. Should we care about the patient’s voice because of its inherent value, or because it can tell us something important about other dimensions of quality? How best should patient judgments be collected and disseminated – through formal surveys or that electronic scrum known as the…

Cutting Healthcare Costs: Searching – Ever So Gingerly – For the Right Words

During my med school psychiatry rotation, I was taught not to shy away from discussing suicide with a depressed patient. “You won’t be suggesting something they haven’t thought about,” my professor told me back in 1982. “By not raising it, you add to the sense of stigma and it just becomes the elephant in the room.” I later came to appreciate that discussing dying with patients nearing the end of life is much the same. From these experiences, I learned that while it’s completely natural to tiptoe around difficult issues, it’s sometimes the wrong approach. I wonder whether we’re making this mistake when it comes to discussing healthcare cost reduction. As with the depressed or dying patient, speaking in code is always risky, since it gets in the way of honest, straightforward dialogue. Moreover, in this case, using squishy language may open the door for misunderstandings, even obfuscation – such…

Swap “Doctor” for” Teacher”

If you have not heard, the NYC Dept. of Education released a report card assessing all of its 18,000 teachers.  It is making a lot of noise, particularly here in the city.  Read the story, regardless of where you live--it is interesting and a policy exercise that is no doubt, coming to a theater near you. (more…)
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